PROSPECTIVE-STUDY OF THE NEED FOR LONG-TERM ANTISECRETORY THERAPY IN PATIENTS WITH ZOLLINGER-ELLISON SYNDROME FOLLOWING SUCCESSFUL CURATIVEGASTRINOMA RESECTION

A long-term cure is now possible in more than 30% of selected patients with Zollinger-Ellison syndrome who undergo gastrinoma resection. The need, however, for continued gastric acid antisecretory therapy in th ese patients remains controversial. The current study was designed to determine whether post-operative antisecretory therapy is needed in pa tients who have undergone successful gastrinoma resection and, if so, to attempt to define criteria with which to identify patients who requ ire therapy. Twenty-eight consecutive patients who had previously unde rgone curative gastrinoma resection were prospectively studied. When a ntisecretory therapy was discontinued, 43% (12/28) of these patients d eveloped gastro-oesophageal reflux, diarrhoea, acid-peptic symptoms or endoscopic evidence of acid-peptic disease within 2 weeks and were de emed to have failed a trial of antisecretory drug withdrawal. The rema ining 57% (16/28) of patients who successfully discontinued antisecret ory therapy were followed for a mean time of 31 months after withdrawa l of therapy. Analysis of acid output studies pre-operatively, as well as at the time of drug withdrawal, demonstrated that patients who wer e unable to discontinue antisecretory therapy exhibited higher pre-ope rative maximal acid output values and higher basal acid output values at the time of attempted drug withdrawal than patients who were able t o discontinue therapy. Despite these findings, there was significant o verlap in acid output values between groups so that it was not possibl e to define specific acid output criteria for successful drug withdraw al. Pre-operative clinical characteristics, such as the presence or ab sence of gastro-esophageal reflux or acid-peptic disease, or post-oper ative laboratory values, such as the fasting serum gastrin level, did not correlate with the ability to discontinue antisecretory therapy. W e conclude that following successful curative gastrinoma resection, 40 % of patients still require antisecretory therapy and that both sympto m evaluation as well as upper endoscopy should be used to guide attemp ted drug withdrawal. Although patients who are not able to discontinue therapy have significantly higher acid output measurements than those who are able to discontinue therapy, neither acid output criteria nor any other laboratory or clinical characteristics are able to predict the need for continued antisecretory therapy in these patients.